The management of chronic pain

Originally appeared in the May/June 2016 issue of Dispatch

This is part two of four in a series of articles that aim to raise member awareness and knowledge of the College’s Guidelines on The Role of Opioids in the Management of Acute and Chronic Pain.

The diagnosis of chronic pain refers to pain that is prolonged, generally of three to six months duration, and subsumes chronic nociceptive pain, central pain and sympathetically maintained pain. These may all cause a chronic pain syndrome, often with a behavioural or psychosocial component.

In dental practice, patients may present with chronic pain primarily of oral-facial origin or as part of, or in conjunction with, another primary pain diagnosis.

Chronic pain conditions in dental practice

Note: This table can be found on page 6 of the Guidelines of The Role of Opioids in the Management of Acute and Chronic Pain.

If the patient’s pain is primarily of oralfacial origin, such as temporomandibular disorders and neuropathic/neuralgic pain, the dentist or dental specialist may be the primary caregiver.

However, if the patient’s pain is not primarily or solely of oral-facial origin, including tension-type headaches and migraine headaches, the dentist should collaborate with or refer to a physician or medical specialist, who may assume the responsibility of the primary caregiver. In such cases, the dentist’s or dental specialist’s role is complementary to the physician or medical specialist, principally in monitoring and/or controlling the oral-facial and/or dental component of the patient’s complaint.

Even if the patient’s pain is primarily of oral-facial origin, the dentist should consider collaborating with other health care professionals, particularly when appropriate pharmacotherapy involves the use of drugs with which the dentist lacks experience or complications begin to exceed their competence to manage independently.

The management of acute pain implies the elimination of a causative disease or disorder, whereas the objective with chronic pain is generally management of the patient’s symptoms and any related dysfunction. This may involve various modalities, including physical treatment, pharmacotherapy, cognitive/behavioural methods, and complimentary or alternative therapy. In rare cases, surgical intervention may be considered as a last resort.

Unlike acute pain, pharmacologic management of chronic pain implies long-term use, which may result in drug tolerance, escalating dosage and increased risks of adverse effects. Opioids are rarely indicated, except for the most severe cases that are unresponsive to other lines of therapy.

For more information about the management of chronic pain, please refer to the College’s Guidelines on The Role of Opioids in the Management of Acute and Chronic Pain in Dental Practice. <add link>

Articles on the guidelines

These other articles explain more about the College’s Guidelines on The Role of Opioids in the Management of Acute and Chronic Pain in Dental Practice, the first dental guidelines of their kind in Canada.

Part One: The Management of Acute Pain

Part Three: The Management of Risk for Opioid Use

Part Four: Additional issues related to the management of pain